Renal denervation

The Setup

RDN can be performed safely in any single plane cardiac or angiographic catheter laboratory. General anesthesia is not required for RDN, but as the procedure is painful, the use of potent opioid analgetics is necessary. Short, or ultra-short acting substances like remifentanil should be preferred, as their effects are easier to control. Additionally, periprocedural intravenous anticoagulation (100 IU / kg) is recommended to avoid thrombotic complications.

Introduction

The interest in renal denervation (RDN) as a treatment for arterial hypertension has returned, with three proof of principle trials that have shown superiority of RDN over sham treatment recently 1, 2, 31. Townsend RR, Mahfoud F, Kandzari DE, Kario K, Pocock S, Weber MA, Ewen S, Tsioufis K, Tousoulis D, Sharp ASP, Watkinson AF, Schmieder RE, Schmid A, Choi JW, East C, Walton A, Hopper I, Cohen DL, Wilensky R, Lee DP, Ma A, Devireddy CM, Lea JP, Lurz PC, Fengler K, Davies J, Chapman N, Cohen SA, DeBruin V, Fahy M, Jones DE, Rothman M, Bohm M and investigators* SH-OMt. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017;390:2160-2170. Link